Baby Joseph to get tracheotomy by the end of the week: U.S. doctors

Sonja Puzic

The Vancouver Sun

3/14/2011

A terminally ill Ontario baby at the centre of a heated debate over end-of-life medical care will undergo a tracheotomy by the end of the week in hopes he could be transferred to a nursing facility closer to home, said the Missouri hospital that accepted Joseph Maraachli Sunday night.

The 14-month-old is being evaluated by a team of specialists at the faith-based SSM Cardinal Glennon Children's Medical Center in St. Louis, Missouri. Joseph was airlifted there "in serious but stable condition" from the London, Ont. Health Sciences Centre, where specialists recommended the child be taken off life support because he suffers from a fatal neurological disorder and is in a vegetative state.

The transfer, via a private plane, was paid for by the American group Priests for Life, which has also agreed to foot the family's medical bills in the U.S.

In a statement released Monday afternoon, Cardinal Glennon hospital's chief of pediatrics, Dr. Robert Wilmott, said Joseph "likely will have a tracheotomy performed by the end of this week to facilitate his transition to a skilled nursing facility."

A tracheotomy is a surgical procedure in which a hole is cut in the patient's neck to open a direct airway. Joseph, who cannot breathe on his own, was on a breathing tube at LHSC and he remains ventilated in St. Louis.

Cardinal Glennon spokesman Bob Davidson said Monday the goal is to set Joseph up with nursing care somewhere closer to Windsor on the U.S. side of the border.

The baby's parents, Moe Maraachli and Sana Nader, have been asking London, Ont., doctors to perform a tracheotomy so they can take Joseph home to die. They had done so with their daughter Zina, who died nine years ago from a condition nearly identical to Joseph's.

But LHSC refused to perform the procedure, saying it's invasive and not part of palliative care. The hospital has vigorously defended its decision, saying the judgment was "sound, both medically and ethically."

An independent Ontario tribunal, the Consent and Capacity Board, and a Superior Court judge both sided with LHSC. But the case sparked an outcry from U.S. pro-life and anti-euthanasia groups, who quickly organized to get Joseph into an American hospital.

As doctors examined Joseph on Monday, the rhetoric outside the facility was flying fast and furious, with a Christian group crediting the conservative TV network Fox News for forcing the child's transfer from Canada.

"It was really so many of our Fox viewers that won this victory," Rev. Frank Pavone told the U.S.-based Fox News Channel, as he appeared alongside Joseph's father Moe Maraachli.

However, with news that the child was in hospital south of the border came a continuing wave of commentary from outspoken anti-euthanasia advocates —an especially strong political force in the U.S. — including a foundation named after Terri Schiavo, which lauded the baby's "rescue" from Canada.

Schiavo is the Florida woman who spent years in a vegetative state before, after a lengthy and high-profile legal saga that even saw president George W. Bush intervene, she died in 2005 after her feeding tube was removed.

"This is a great victory for Baby Joseph, his family and for all the people and organizations that were committed to helping this precious child," said Bobby Schindler, executive director of the Terri Schiavo Life & Hope Network. "Baby Joseph was hours from being pulled off life support at (the Ontario hospital) before his situation made national headlines, forcing the hospital to cease its efforts to end the baby's life."

Speaking on the Fox show America Live on Monday, Pavone said his group sent out "action-alerts" to which thousands of people responded by contacting the London hospital and applying pressure.

Pavone said his supporters were "targeting the hospital in a clear, firm, but respectful way."

"We're not saying that people should be kept alive at any cost. Nor are we saying that there's any specific treatment plan here that we're imposing," Pavone said. "What we're saying is 'Give the baby reasonable care and listen to the parents who want to give the baby a second chance in an American hospital.'"

Maraachli, who joined Pavone on the Fox broadcast, said he would "accept and respect the second opinion of the hospital in St. Louis."

"When God wants to take his life he will take it. And nobody can say no to God," he said.

A statement Sunday night from the London hospital, announcing the transfer, acknowledged the intense pressure the facility had been under.

"Physicians and staff were targeted by well-organized social media feeds and directly via email with personal threats, threats to their families, innuendoes and falsehoods. The threats, many of which emanated from members of U.S.-based groups, have been passed along to LHSC lawyers, who will liaise with police where appropriate.

"Despite these intimidation tactics, LHSC physicians and administration continued to explore all available legal options to ensure that the best interests of Baby Joseph were met and Baby Joseph was provided with compassionate, quality care up until and during his transfer to London airport."

About a dozen U.S. hospitals turned Joseph down, likely out of fear of all the media attention surrounding the case, said Rev. Frank Pavone, national director of Priests for Life.

But Wilmott said Cardinal Glennon hospital is "pleased to be able to assist the family in this very challenging time."

In a news release, Pavone described Joseph's transfer from London as a "rescue mission," done "under the cover of darkness."

"I said that because that's what it was psychologically for the family," Pavone said in an interview.

But the family's Windsor lawyer, Claudio Martini, who negotiated Joseph's release, said LHSC was co-operative and "respectful" of the parents' decision.

The hospital had an obligation to ensure that Joseph was going to a properly accredited facility and that he would be safe during transportation, Martini said.